Prevalence and Determinants of Multidrug-Resistant Tuberculosis among People Living with HIV: A Systematic Review and Meta-Analysis

Vollständiger Abstract

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Multidrug-resistant tuberculosis is a major challenge for TB control, having added effects on human immunodeficiency virus (HIV) positive individuals who are more prone to TB acquisition and delays in diagnosis, as well as negative outcomes from treatment. This systematic review and meta-analysis reviewed and pooled data regarding multidrug-resistant TB prevalence and determinants among HIV purgent TB patients. Observational studies between January 2010 and July 2023 were selected for this study from PubMed, Google Scholar, and ScienceDirect. Eligible studies reported confirmed resistance to at least isoniazid (INH) and rifampicin (RIF) and provided multidrug- resistant tuberculosis (MDR TB) data among human immunodeficiency virus (HIV)- infected individuals. An initial total of 1603 records were found, of which 415 were deemed duplicates, and 1188 titles and abstracts were screened, and 148 full-text reports were evaluated. A total of 54 studies in 36 countries, with 430,534 TB patients, were included. Association estimates were pooled using random-effects models, and heterogeneity, subgroup effects, sensitivity, and publication bias were assessed. Due to heterogeneity (I2=75.8%), there were 42% increased odds in HIV-positive TB patients for developing MDR-TB, compared to HIV-negative TB patients (OR=1.42, 95% CI: 1.17-1.71). Factors found to be associated with primary multidrug-resistant TB included treatment for at least 14 days (odds ratio = 2.76), treatment at a clinic in Southeast Asia (odds ratio = 1.86), treatment in high-burden countries (odds ratio = 1.75), and age of 40 years or older (odds ratio = 1.56). Important determinants were previous tuberculosis treatment, treatment failure, poor adherence, delayed treatments, contact with healthcare, and contact with tuberculosis-resistant cases. Egger's test detected no small study effects, and sensitivity analyses confirmed the overall association. The results confirm the need for universal drug-susceptibility testing, integrated tuberculosis–human immunodeficiency virus care, earlier initiation of treatment, adherence support, and enhanced infection- prevention activities for people at high risk.